An update of the cervical cancer staging system as of 2019
Affiliation and adress for correspondence
1 Division of Gynecologic Oncology and Department of Oncology, Wroclaw Medical University, Wrocław, Poland
2 Lower Silesia Oncology Centre, Wrocław, Poland
3 Club of Young Gynecologic Oncologists affiliated with the Polish Gynecological Oncology Society, Poland
4 Department of Gynecology, Holy Cross Cancer Centre, Kielce, Poland
5 Division of Surgical Oncology, Department of Oncology, Wroclaw Medical University, Wrocław, Poland
Correspondence: Piotr Lepka, Division of Gynecologic Oncology, Department of Oncology, Wroclaw Medical University, pl. Ludwika Hirszfelda 12, 53-413 Wrocław, Poland, e-mail: piotr.lepka@umed.wroc.pl
Curr Gynecol Oncol 2019, 17 (1), p. 10–18
DOI: 10.15557/CGO.2019.0002
ABSTRACT

Staging systems for malignant neoplasms are basic tools needed for correct assignment to oncological therapy, proper decision-making about adjuvant treatment, comparison of therapy outcomes and for ensuring consistency of clinical studies. The International Federation of Gynecology and Obstetrics (FIGO) was the first to develop their own principles of staging for malignant cancers of the female genital organs. Over the years, together with the progress in diagnosis and therapy of gynecologic cancers, the staging systems for all malignant neoplasms have been revised several times. The goal of this article is to compare the latest FIGO staging system for cervical cancer from 2019 with the previous version from 2009 and to discuss the most important clinical implications that its implementation into daily clinical practice will ensue. The new FIGO staging system for cervical cancer is no longer a purely clinical classification. For the first time, it also involves imaging and/or pathological findings. In the staging system from 2019, tumor size ceases to be a significant parameter in stage IA, but it merely depends on the depth of invasion. Stage IB has been divided into three substages depending on tumor size: IB1: depth of stromal invasion ≥5 mm and greatest dimension <2 cm, IB2: greatest dimension ≥2 cm to <4 cm and IB3: ≥4 cm. Stage II takes into account the possibility of using imaging and/or pathology for evaluating tumor size and extension. Stage IIA1 includes tumors with the diameter <4 cm, while stage IIA2 includes tumors with the size of ≥4 cm. Moreover, stage IIIC has been introduced. It involves patients with involvement of the retroperitoneal lymph nodes with a proper notation (“r” or “p”) depending on the technique employed to verify the lymph node status (imaging or pathology, respectively). The implementation of the new staging system will allow more accurate association of the FIGO stage with the actual clinical situation. To date, it has been commonly believed that once a disease stage has been assigned, it should not be changed, even when new clinical data arrive. In the new FIGO staging system, it seems justified to supplement the assigned stage following surgical verification or more advanced diagnostic tests, with an added note: “according to FIGO 2019.”

Keywords: cervical cancer, cancer stage, FIGO staging system, gynecologic cancers